Abstract
BackgroundVentilatory management of respiratory failure with pneumomediastinum/subcutaneous emphysema is not established. Herein, we report a case of severe COVID-19 pneumonia with extensive pneumomediastinum/subcutaneous emphysema, rescued by thorough lung-protective ventilatory management after applying the VV-ECMO.Case presentationA 68-year-old male with no medical history was admitted to a local hospital and diagnosed with COVID-19 pneumonia. His pulmonary parameters worsened during invasive ventilation due to the development of pneumomediastinum/subcutaneous emphysema, and then he was transferred to our hospital. On arrival, we immediately decided to apply VV-ECMO and switch to ultraprotective ventilation. After maintaining the initial ventilation with a neuromuscular blocking agent for 2 days, we gradually increased PEEP while limiting PIP to 25 cmH2O. The patient was weaned off VV-ECMO on day 10; he was transferred to the medical ward after extubation.ConclusionsLung-protective ventilatory management should be performed thoroughly during VV-ECMO in severe COVID-19 pneumonia with pneumomediastinum/subcutaneous emphysema.
Highlights
Ventilatory management of respiratory failure with pneumomediastinum/subcutaneous emphysema is not established
The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) to switch to ultraprotective ventilation has been reported as a helpful tool [2]
We report a severe COVID-19 pneumonia patient with extensive pneumomediastinum/subcutaneous emphysema rescued by thorough lung-protective ventilation management after applying the VV-ECMO
Summary
Lung-protective ventilatory management should be performed thoroughly during VV-ECMO in severe COVID-19 pneumonia with pneumomediastinum/subcutaneous emphysema.
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